Midwife Reform Bill Moves Ahead in Albany
June 8, 2010

Licensed professional midwives would be able to practice independently under a bill that was favorably reported from the Assembly Higher Education Committee this morning. “This is an important step forward for women’s health,” said Assembly Health Committee chair Richard N. Gottfried, author of the bill, A. 8117. The Senate bill, S. 5007, is sponsored by Senate Health Committee chair Thomas K. Duane and is on Wednesday’s Senate Higher Education Committee agenda.

Professional midwives have been licensed in New York State for decades. They provide prenatal care, deliveries, and primary gynecological care. However, they are required to have a “written practice agreement” with an obstetrician or a hospital that provides obstetric services. The bill would repeal the requirement for a written practice agreement.

“The 1,300 licensed midwives in New York perform about 15% of the non-Caesarean deliveries, with exceptionally high rates of successful outcomes and patient satisfaction,” Gottfried said. “The written practice agreement is an unnecessary restriction that blocks many midwives from serving the community.”

When a pregnancy or delivery develops complications or becomes high risk, a midwife refers the patient to a physician. While some people associate the word “midwife” with home birth, the vast majority of midwives deliver babies exclusively in a hospital.

“Every physician commonly has to refer a patient to a specialist or a hospital, but the law doesn’t bar them from practicing without a written practice agreement with specialists or hospitals,” said Gottfried. Midwives currently practice in 15 states (AK, AZ, CT, DC, ID, IA, ME, MN, MT, NH, NM, OR, RI, WA, WY) without signed practice agreements.

“Too often, the written practice agreement requirement is an obstacle to midwifery care,” Senator Duane said. “In some rural communities, there are no physicians available and willing to sign an agreement. The written practice agreement requirement can be an obstacle even in urban areas. When St. Vincent’s Hospital closed in April in my district in Manhattan, midwives affiliated with the hospital or the hospital’s physicians had to scramble for new arrangements.”

In New York City, St. Vincent’s was one of the only hospitals that provided written practice agreements for midwives who do home births. Hundreds of their pregnant patients were left without care when St. Vincent’s closed. “Many of the home birth midwives remain without written practice agreements, causing upheaval for families who had chosen home birth in the expectation of a peaceful birth experience without medical intervention,” said Gottfried.

“In rural Tompkins and Cortland counties, we have several midwives who are being forced to leave the community because the local physicians are not willing to sign agreements with them,” said Assembly Member Barbara Lifton, who represents that area. “Their malpractice insurance company may think it adds to the physician’s liability, or some of the physicians don’t want the competition. But the result is a more severe health care shortage for the women of New York.”

“All three of my children were delivered by a midwife,” said Assembly Member Amy Paulin. “We chose home birth for two of them. I live in Westchester. The midwife was affiliated with a hospital in the Bronx, about half an hour away. If I had needed to go to a hospital, we would have gone to the nearest hospital in Westchester, not to the hospital in the Bronx. So the written practice agreement was totally pointless.”